Our trip home.

We were able to get tickets out of Davao several hours earlier than planned.  This got us to Manila at a decent hour to get some sleep.  We slept in a Christian hotel, and they had a unique set up for dinner.  Open cooking, they had seafood and vegetables.  You chose the piece of seafood you wanted, they cooked it.  I had a couple shrimp and some adobo greens and rice with a watermelon shake.  Tom had a couple prawns, some fish and rice, along with a mango shake.  All of this for under $20.00. 

We ordered breakfast up to our room, as the kitchen  for free breakfasts opened at 6:00 am and we had to leave at 5:45.  We ordered scrambled eggs, sausage and toast and hot chocoloate.  We got scrambled eggs, hot dogs, toast and coffee.  Anyway, we ate what we could and then left in time to get to the airport.

With 2 huge suitcases, 4 smaller suit cases, my back pack and Tom’s study materials, we had quite a load.  I really don’t know how I would have managed coming home by myself.  Tom had taken one look at my rinky box held together with duct tape and promptly went out and got some luggage.  We spent about $20.00 on 2 luggage sets at Davao’s biggest mall, that really suited us well.  The gifts we got for everyone, fit in just right.

Our flights home we uneventful, except for in Davao, they almost took my sea shells.  The guard was very compassionate and looked left, looked right and stuffed them back into my suitcase and stuck a “fragile” sticker on the outside of the case.  He said to tell the guards that they are “finished product”.  We did not encounter any trouble in Manila.

The long ride home was loooooong.  One flight I sat in the seat for 8 hours without getting up once.  The meals were airplane meals, but tasted good.  3 movies later, we landed gracefuly in Portland, Oregon.

In Portland, we almost missed our flight to Spokane,  becuase our flight from Japan to Portland was very late.  We had 1/2 hour to get through customs with all of our luggage, get through security again, get a boarding pass and get from one end of the airport to the other. 

We arrived home safely to Spokane. The Poole family brought our car for us to the airport, so we could get straight home.  3 hours later, we were home.

The children were very excited when we arrived.  Balloons and welcome flowers greeted us.  They could not wait to look at the gifts.  After several hours of oooos and ahhhh’s we collapsed in a heap to sleep (after being awake for over 24 hours.)

 

 

 

 

2 Wonderful days with Tom and good byes…

We were able to spend 1 night at Paradise Island and toured the island, via a jeep.  It was a very rough ride, but interesting.  I think that now we have a really good idea of what this part of the Philippines might be like, in the city and way out in the country.

Here are some pictures of us on our tour…  there are so many pictures I have taken that I wish I could share.Paradise Isand with Tom 005

One of the stops they took us to was a big cave that over 1 million bats call home.  This bat colony really smells.  In fact is was very nausating.  I remember this smell from my childhood and recall a barn that really reaked like this.  Now I know what the smell was!

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Here is Davao City just before sunset.  It was really raining, so the sunset was not very spectacular, but I know that they can be here.  This is a overlook called Jackson’s ridge.  they have a resturant and places to sit and see the view.

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Here is an Assemblies of God church.  they have many outreach churchs of all faiths.  Mostly the more common denominations, along with a fancy Jehovah’s Witness building and a Mormon building.

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Tom is front of a bakery that we stopped and bought some bread and cookies for our lunch.  Paradise Island had packed us a lunch to take that consisted of plain rice, garlic broccoli, a pineapple and a mango cut up. 

 

 

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We took a hike to some waterfalls for a picnic lunch.  We had to cross several “bridges” to get to our cascading waterfalls and eating place.  Here is Tom just coming off one of the bridges.  He is carrying lunch.

 

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Here is our picnic spot.  We stayed and shared lunch with our guide named Drdr. 

 

 

 

 

 

 

The surprise of my life..

 

It was early morning.  I had just woken up and lazily lying on my mattress on the floor (I like it there). I yawned and stretched.  There was a knock on the door and Krys poked her head in the door and said very concerned, “  You have a patient downstairs that is really upset and she needs to talk with you right now…”

            “Oh dear… is it Phoebe?” (the young mom with the tiny baby ‘Peanut” )  I have been concerned about them.

            “Yes, I think that’s who it might be…” 

            Lots of questions ran through my mind all at once…So I jumped up in bed, really worried.  Is the baby sick?  Why can’t Krys handle it, she speaks much better Cubano than I do…  Maybe Phoebe is in trouble.  Why does she want only me?  None of it made sense.

            Getting to sleep at 1:30 am last night, because of a birth, I was really rummy and not thinking very well.  I wriggled into a already worn dress, put my hair into a alligator clip, deciding to put it up while I talked with Phoebe.  I grabbed my bag of tools, my computer (to check if Tom had sent an e-mail and my back pack.)  I raced down the stairs, out the door and over to the clinic.  Walking through the clinic door, the curtains were closed around the nearest cubicle.  (Not a big deal, since in the AM interns that are not working are sleeping.)  I walked around the corner, and looked at one of the students who had a camera pointed at me.  I stopped in confusion.  What?  Everyone was silent. (This seems all slow motion to me)  I looked to the left, onto the bed expecting to find Phoebe….. and there was Tom sitting with his feet up on the bed, smiling from ear to ear.

            My mouth hung open for a very long time.  I was shocked.  I couldn’t speak.  I just stood there staring.  It was as if time stood still.  My mind was in a fuzzy state anyway.  Then my legs somehow managed to start moving again… to the other side of the bed.  I was in his arms……  I was shaking like a leaf….  He kissed me soundly and we hugged again and again.  I was still in disbelief…… Here are pictures of all of this   I look incredibly silly with my mouth hanging open, my hair in the alligator clip and dressed a wrinkled old dress!

            I was totally useless for about 1 hour.  I couldn’t think where my key was to get into the house.  I was going up to change my clothes and put my hair into some kind of order….  When I couldn’t get into the house, I turned around and went back into the clinic kitchen, where Tom was waiting and I decided to do my hair there.  I got my hair up into my bun and then spent 5 minutes rummaging around in my back pack looking for my hair pins. (all ready in).  I must have seemed to Tom like I now had ½ a brain.  All I could do was stare at him and mumble glib answers to his questions.

            It is now 24 hours since we have been together and after a good night’s sleep, I am doing better.  Mentally adjusting to having him here, instead of all of my dreaming about how I would look getting off the plane, what I would say when I returned, all went out the window.  The Lord knew all of this was going to happen, and so did Tom, my family, my church family and even Matt and Krys here.  They did a fantastic job keeping clam about Tom coming to get me.  I have truly NEVER been so surprised in all of my life… 

            So, now it is Wednesday morning.  We had breakfast in the Insular Waterfront hotel where we spent the night, and are heading off to Paradise Island for our last night here.  This is the same place, where I cried tears of longing, just not even a week ago, for  wanting to share this beautiful place with Tom.  I cannot believe how good God is to me… This is truly an incredible conclusion to this midwife drama… called the Birth of a Midwife….  Thank you everyone who worked hard to make Tom’s coming possible.

            We leave tomorrow evening to start our journey home.  Flying out of Davao and to Manila at 9:45 at night.  We sleep in Manila and then fly out toward Japan at 8:15 am.  We then fly from Japan to Portland, then Portland to home… I am so very glad Tom is here to do all the thinking about timing and all.  I am really not too bright right now.

            So, we will be home the afternoon of the 14th.  I cannot wait now to hug my children.

Tom Waiting

 

Tom Waiting behind the closed curtain….

 

 

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Sherry in total, absolute shock!

 

Sherry meets Tom

 

In his arms at last!!!

 

 

 

 

 

           

It is now 3 days until I fly out of Davao City to Manila and head out across the ocean towards home.  On my Thursday, I am spending the night in Manila and my plane leaves at 8:15 in the morning for Portland, OR.  I am so much looking forward to being home.  Words cannot express what my stay here has done for my ability…  my thoughts about catching babies and about myself and my limitations.  And yet I am so very, very anxious to be home and settle into being wife / mommy again.  Nothing like a little time away to help me reflect and decide what I want to do differently for the better! 

Much of my afternoons lately are spent doing postpartum exams and newborn exams.  I am the last intern to leave and so I get all of the postpartum and newborn exams everyone left behind.  So that is good… but sometimes I have them lined up pretty deep waiting for me.

The clinic was pretty busy… yet I am so tired (always am) Yawn….so I decide to take a quick nap on the bed below, just taking a “short nap” before some of my mom’s were due in for postpartums.  1 hour later, I awoke with a start to find 4 pairs of dancing, laughing eyes holding babies looking at me.  All my postnatal moms had decided to show up at once and there I was snoozing away for over 20 minutes with them sitting within 3 feet of me, quietly waiting for Punta midwife to wake up!  I am sure I had sleeping lines on my face and probaly had my mouth hanging open or drool or something.  They are always so polite…

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I only have 3 more shifts left, and I need 3 more births for the 17 complete handles required for my Associaiton of Texas Midwifery school I am going through.  3 more additional will be at home with Joyce, as they need to be continuity births from 15 weeks on until birth and then 6 weeks afterward.  I have way over the 40 I need for Montana. And way over the amount of prenatals and postnatals and newborn exams for everyboby, which I am very thankful for.  So, whether I get the 3 in the next few days, is not a terrible big deal to me, as Joyce and I have more births this year yet too.

Last night I had night shift.  I was pretty tired and so I went to sleep on the bed above… see my pillow!  This is where I hang out a lot when things are slow.  Suddenly the guard calls  “Labor!”  Up I jumped!  A mom had just come in the gate, after getting out of a Taxi, by the road and could hardly walk.  Her bana was trying to support her as she walked.  I had my clinic shoes on, so I didn’t go out and help support, but somehow she made it to the doorway.  We then hustled her over to a bed… ( I am still walking in my sleep).  Sure enough, she wanted to push.  The baby’s head was visible. Once again, I yanked on gloves, wheeled the birth cart over, and someone else got oxygen and pitocin.  We did get heart tones and they were very low.  I stimulated the baby’s head and urged her to push harder.  But not too fast… we don’t want to rip.  8 minutes later, from the time she entered the door to the center, she was born.  As the baby’s head was crowning, the cord appeared on top, so I looped it over the head to the side, out of the way. So it turned out that she had a nuchal cord that was between her head and the canal and had slowed the oxygen down getting to her. She was very dusky and slow to start…. I always hate that…( I was awake now!)    Anyway, after a few resuscitaiton breaths with oxygen and blow by for awhile, she perked up good enough.  She was also a big baby.  It was big baby night..

The baby before that same evening, had really stuck shoulders.  It was the typical slow to progress labor that these bigger babies that are having a hard time descending into the pelvis have.  It took her forever to get from 4 – 7 and then another forever to get to 7 – 10.  The head was asynclintic too, sort of chin tucked way down and off to the side.  The head came out dark blue and then retracted in a bit against the perineum.  Uh oh… We tired briefly to get baby out and realized that the shoulder was pinned under the pubic bone.  Elizabeth held onto the baby’s head, as I quickly brought mom’s knees way up to her chest and had someone hold them there.  Mom stopped pushing, then I did supra pubic presssue, while Elizabeth pulled down.  Then the shoulder slipped under the pubic bone and swoosh, she was out.  Non-responsive. White with very blue head, I stimulated the baby and we grabbed resuscitation equipment and gave baby a few good breaths.  Finally with a little cry she started to pink up and respond.  Thank you Lord!  She was only stuck for about 2 minutes, but it always seems forever while we are trying to get a baby out like that and breathing on her own.  Time almost stands still.  We used blow by oxygen for about 1/2 hour. Baby had chest retractions and nasal flaring for a while.  But perked up after nursing and thankfully we didn’t have to transport. She was actually a stong baby and withstood all this in good stride.

I think that I will write a book called  “The Birth of a Midwife”  but maybe someone already has… Anyway, that is how I feel.  I affectionately call my stay at Mercy Maternity,  Midwife Bootcamp.  It fits.  I am exhasted and being pushed harder than I ever have been in some ways.  I have grown in confidence.  I can go home now and feel a bit more prepared to be of good use to Joyce.  I am expecting to have a bit of a hard time with jet -lag and so your prayers will be much appreciated as I integrate back into home life and a heavy schedule.

 

 

Tour of Mercy Maternity Clinic

I thought that maybe since the clinic was quiet except for my one postpartum mom, I’d share some pictures of the clinic.  They have a beautiful way of keeping things very simple.  I have learned that simple is better… after all, babies come out without scads of equipment.  The essentials like oxygen for mom or baby is always available.  The birth carts are very uncomplicated.  Big, clean, birth pad, some blue towels, a baby blanket, some gloves, some sterile gauze for looking for tears, a cord camp, scissors, gloves, bulb syringe, and Pitocin.  That’s it.

 

Simple birth uncomplicates the process of birth in my mind.  Being here has done several things for me.  It has given me more knowledge and confidence.  It has helped me with skills that I might not get to practice in the states.  On the other hand, it has really made me see how much more I need to understand and just how many different ways there are to approach problems in labor and birth.  (Each supervisior has a different approach to the same problem. Thing makes learning really interesting.)

 

Emergency management of hemorrhage, a baby with stuck shoulders or even true shoulder dystocia and a baby who is slow to respond and get going… these are regular occurrences here.  It almost seems common to me now, but I have to remember that when I get home, I will see it much less… But I will know what to do!….

 

I really like how calm and ready for action the midwives here are.  They seem to know what is going to work and when to transport.  They have their perimeters, imposed by the hospital rules… and yet they do have some leeway if they think a mom can pull it off.  Because of the high risk, under nourished, moms, we do transport a lot.  High blood pressure, SROM over 12 hours, with no labor progress,  babies not getting around the pubic bone (pushing for over 2 hours) or contracted pelvis and severe hemorrhage after placenta is out (1,500cc to 2,000cc ) are the most often reasons for transport.  Also babies that are not breathing well or moms unable to cooperate with instructions are some other reasons.

 

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This is the clinic enterance.  60 to 80 woman line up here 5 days a week to have their prenatals.

 

 

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Here is the basic clinic.  There are 6 single, wooden, beds in this room and then 2 beds out in the big area. Every bed  is separated by curtains.  Each cubicle has a single bed with a 2 inch plastic mattress, with a sheet and a flat pillow with case.  A single sheet is for covering mom.  A piece of  heavy plastic covers the middle of the bed and is washed by the bana after the birth before they can go home.  the room also includes a black 3 tired stand, and a white plastic chair.  There are two birth carts, 2 oxygen tanks with tubing for mom and one for baby..That’s it. There are fans everywhere, as it get blazing hot in here!  I don’t know how many births I have done with sweat dripping off my nose.

 

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Here is the midwife’s area that we hang out in, between births.  I sleep here, eat here and have in depth conversations about everything with my fellow midwives on shift.  Rose and Anna are using my lap top getting their e-mail and I snapped a picture of them.

 

 

Here is the winner of the mellow baby award.  Most little ones yell when I bathe them.  This little guy seemed to like it.  His daddy was giving him his bath.  He was not a happy camper, though a few minutes later when I gave him his injections.  He recovered quickly though. They named him Lorenzo Mari Talo

 

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I have so many pictures, I just can’t wait to share them with all of you.

For now I will think about how to put them all in a logical order with text

 

 

 

Escape to Paradise Island..

Yesterday, I was totally exhausted, mentally and physically.  On the spur of the moment,  I decided to go to Paradise Island for the night.  I am so glad I did!  I slept for almost 12 hours straight in my simple but safe room with two single beds. It was so quiet.  No guy riding a bike by shouting at 4:30 am to sell Mya Buko, (deep fried, ½ embryo eggs) the rice peddler or fighting cats or anything!  After I arrived, I walked on the beach for a couple hours.  I tried to get a sun burn, but I just got browner.

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 I am doing much better.  I have a happy outlook on life again and I feel alive… like I can do this.  It took some courage on my part to leave the house.  But all went well on this trip, and I did take a taxi for most of it.  I just sat in the sand, numb, feeling the waves and sand… picking up a few shells, crying a bit… and went to sleep at 7:00pm.

  I awoke at 6:46 am.  I took my time getting a nice warm shower… not HOT!  Or COLD! I ate a nice quiet breakfast of steamed fish and ginger.  I also had strawberry crepes, but they forgot the strawberries and just used jam…

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  I left the island at 9:45 am and went to the big, big mall.  There I found some more material for dresses and some great Tea Rose perfume that I have been looking for, for years, and a nice new jean jacket… for me.

 

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I got here at the clinic for work at 12:00 pm, got into my scrubs.  At 1:37 pm,  I just delivered my 13th baby and now I need 4 more for my 17 total.  In addition, I have assisted in some way, with way over 50 births, including the 12 transports.  I think I learned more during the transports!

3 births, and a wild woman…

When it is about to rain, in pour the labors.  It was no exception to that rule this evening.  We had 3 at once.  It seems that there really is something to the falling Barometer deal.

The first one was a mom who had been laboring here all afternoon.  Her name is Beautilyn and she did a wonderful job at pushing her baby out.  At 4:57 pm she had a baby boy.  Only thing is that she bled and kept on bleeding off and on.  At one point, her banti helped her change her diaper (pad) and then told the guard that she was bleeding… but didn’t bother to tell the midwives… so we do not know HOW MUCH she bled.  She was looking pale and weak, so we started an IV and did a manual removal of clots and found a membrane piece and maybe a small piece of cotyledon from the placenta.  She stopped bleeding after that.           

            The next mom, Calle Deosyl, came in at 8 cm and pushed a baby out 9 minutes after the above mom did.  I was able to assist both of the births by actually receiving baby and helping evaluate apgar score, cutting the cord and charting.  Calle gave birth at 5:06 pm to a baby girl.  She also bled a huge amount after placenta came out and we started an IV on her right away. EBL 800.  She stopped after the major gush with the placenta.  It just was a WHOLE lot at once.

            The third mom, Ma. Cindy Traabucon was a G3 P3 and came in during the hemorrhage management of the two above and was 8 – 9 cm.  She gave birth at 6:49 pm. EBL only 75cc, thankfully.  I assisted by charting and doing most of the immediate postpartum checks.  Her estimated due date was 9/18/07 and her baby boy looked really frosted with vernix  when he came out.  There was moderate to heavy fresh meconium in the water, so this baby was deep suctioned immediately upon coming out.  Deep suctioning means that they put a thin tube down the baby’s throat and nose to get the fluid out of the esophagus and stomach and nasal passages. This may or may not help, but is hospital protocol.  They also use the bulb syringe routinely because it is hospital protocol.  So even if the baby is not gurgling, we use the bulb syringe. I use it sort of as a token suck in the mouth then nose and then put it down.  Babies do fine without it, for the most part.

            Earlier this afternoon, we had an 18 year old mom in labor with her first baby, that we worked with all morning in labor and then for about an hour and ½ with pushing.  This was the first “wild” woman episode I have seen here.  She was flailing around on the bed, screaming in pain.  She grabbed her bana and shook him.  She hauled on his neck, his waist and anyone else that got near.  Bruises all around for anyone within reach, I am sure. She kept crying out in pain while pushing and was literally sobbing and begging for help. She would lift her bottom up from the bed and try to crawl away from the pain, literally. We had her try various positions and tried to comfort her.  The Pinoy midwives were a little annoyed with her for acting out like this.  Their culture dictates that a woman labors quietly and makes no noise… not even with pushing.  She desperately needed a mommy.  And although her mom was there, she wasn’t much help, but just looked on horrifed and kept trying to get her to be quiet. Although it is fine here to make noise while in labor and pushing here at the clinic,  many times the bana or banti will try to shsush the birth mom from making any nose louder than a talking voice.  This mom was yelling so loud, we were afraid that the neighbors would complain.  Thankfully the clinic was almost empty at the time, except for a few woman and their babies waiting for their postnatal and newborn check ups and the last of the woman just leaving from their prenatals upstairs.  This mom eventually did get down to work to push very well for quite a while, but the baby’s head just would not come under the pubic bone, no matter what position we tried. Then the baby started getting tired and having late decels of 70….80…. and 90, so we transported.  I could hear her yelling outside and even in the ambulance as they drove away.  The way the ambulance driver gunned it out of here,  I think he was in a hurry too, for the sake of his ears.

            So that was the gist of my shift today along with 12 prenatals in the clinic this morning.  One breech baby, one mom who thought she was 17 weeks along, but no baby to be seen. And several moms with very low iron and one with a raging UTI or vaginal infection of some kind.  It seems that all of these moms are high risk, with the exception of a few souls that try hard to eat well.  Actually eating enough vegetables is not hard here, it is the everyday protein issue.  But eggs are fairly cheap and can be bought individually.  An egg a day and a plate of greens would go a huge way in making a healthy baby and mom.  But instead, their diet of white, processed bread products, lots and lots of white rice and minimal protein creates unhealthy placentas and babies that are not very vigorous.  There are no whole grain bread products for sale here and most families do not have any way to bake anything.  Oats, and cornmeal are available in the grocery store in the mall.  It is expensive for them and I can tell that mostly the white foreigners buy it because it doesn’t move very fast.  I really have to watch the shelf date.  Grainola and hot cereal are available here and I have literally lived on it for breakfast while I am here.  This hopefully counteracts the white rice I eat everyday. 

 

           

 

 

2 births, a baby bath and a Muslim family…

Today I reported for clinic at 6:00 am, very groggy and sort of hoping that I could have a chance to wake up a few hours before any labors came in.  My wish was granted… for a little while.

            I went in to assist another midwife, that had taken this mom over in endorsements, from another midwife who was heading to bed.  This particular mom was in a lot of pain.  She cried out and moaned all night, since she had been admitted in the wee hours of the morning.  I think that the fear…tension…pain cycle is so true.  Blatant examples this are seen here all the time. I wish so much that I spoke the language so I could work with some of the moms, helping them to understand that what their bodies are doing is natural and it’s  O.K.

            This mom finally was fully dilated and started pushing, sort of… She cried out with each push and was having a hard time focusing down below.  She would throw her head back and lift her bottom off the bed and scoot, trying to get away from the pain.  She pushed for 1 hour, and then 45 minutes… then her baby started getting worn out.  Heart tones started taking a nose dive after contractions… late decels meaning that her baby was not getting enough oxygen.  We put oxygen on the mom and listened for a few more minutes.  Carmen started an IV.  I called out the heart tones every 6 minutes as I counted them with the doppler.  90…..100….80….70…80……70….65…..70….  Yikes  normal is 110 – 160.

We could see the baby’s head, but we were a long way from getting that baby out.  We decided to transport, because the birth would be safer in the hospital where they had better resuscitation equipment… (well not really, but the rules say we needed to transport).  It was better that way anyway, because I don’t like dead babies and we just could not tell whether this one was stuck or not, as it was coming so slowly through the pelvis.

            They flew off in the little blue ambulance after getting her loaded up out of the wheel chair.  She delivered after being in the hospital not very long… The baby is safe.

           

            My second birth of the day was right after 2:00pm endorsements.  The midwife on shift had gotten her settled and thought that she might go pretty quick.  She handed me the file and said like… quick! I mean right now!…So I jumped up and grabbed a birth cart, oxygen and yanked on gloves… (sound familiar). And she was pushing.  3 pushes and the baby was out.  I again worked really hard at getting the baby’s head to stretch the perineum slowly, but the baby came so fast…  number 5 for her.  That he just sort of slid out onto the bed.

            A little boy.  He seemed very healthy and pinked up right away. This family is Muslim and just the birth mother-in-law was there to help her.  At least the dad was not there this time to whisper in his baby’s ear before his little one hears anything else, “Allah is God, and there is no other…” The Muslim dads all do that…

            The mom speaks almost no English and really doesn’t talk much at all.  It is so strange not to be in communication with the birth moms I am helping.  It makes the situation seem kind of “not real”, but they are very real…. There is lots of blood with this one to prove it.  This mom bled about 600 cc which is not too bad.  Still, my heart was with her as she kept throwing big clots and trickle bled, even though I was really squeezing the uterus firm every couple minutes. I gave her some pitocin.  Finally, about a half hour, she slowed way down and she is fine now. 

I, with baby in one arm and her clean clothes in the other, we slowly made our way to the bathroom.. It amazes me that she is not dizzy.  She even balanced on one foot to get dressed in the soaking wet bathroom.

            The bathroom has big white, tile flooring and a huge bucket with a scooper that is used for flushing the toilet and washing off.  We slosh the toilet off, too with it.

            After getting her settled back in bed and resting, I did the baby exam.  I heat the big tea kettle on the gas stove and get the green plastic baby bath out the back door, where it is hanging from the last use.  I fill the baby bath with a little hot water from the now steaming kettle and some cooler water from the sink facet.  I touch the water with my elbow… Yes, I hate scalding babies…. My hands are pretty numb to heat after all the years of mothering and washing.  I adore very hot baths…. (Ahhh a hot bath… I have not had one in a very, very, long time.)  But babies do not.

            I carefully carry in the warm water bath and place it on the bed beside the mom.  I then ask for the bar of soap that they generally have brought.  I unwrap the baby and lower them in the water, carefully swishing them off, getting rid of the blood and mec. Most of them holler and are not happy with me. If I hold one arm pinned to their body as I wash, sometimes I can get a quiet one.  I soap the head, wash it off and rinse off the rest of them and turning them on their backs as I am taking them out of the tub, do a quick exam for any anomalies.  We do find some occasionally.

            After the bath is done, I wrap up baby and whisper in his ear that he probably won’t like this next part, and I am terribly sorry, but it is the rules… and I will try to be as quick as possible. Next I run out to the fridge and get the vitamin K shot and draw up the HepB syringe.  Then I get a cotton ball with alcohol saturated and steel myself for the most unpleasant task of this whole thing.  We have to record which leg we inject what, and what time and the date, after we footprint them with ink on the newborn exam form.  They don’t like being messed with on their feet… but the 2 needle pricks are worse.  After my dastardly deed is done, I wrap them up and give them back to mama to nurse.  Sigh… sorry little one….

            The paperwork in the clinic is just a reflection of this paperwork-happy-country itself.  There are literally reams of paper work and everyone seems to think it makes things more official.  So, the birth certificate paperwork is 5 pages long and sometimes 6 if the family is Muslim.  The birth record form itself is 5 pages, each having a special purpose and part of labor.  They document EVERYTHING here.  Papers to get into the clinic, a paper to get out (to show the guard).  Paper that proves you are married or a tax schedule that shows you are a household with your housekeeper.  Anyway… you get the idea.

            Tonight the Pinoy midwives are all singing in the kitchen with much gusto and laughing.  They are singing Philoppino Christian praise songs and using a small congo drum, spoons on the counter, a guitar and their voices.  I wish I could tape it and put it on the web so you could hear it.

            My birth mom just wandered by to the CR  (comfort room) again, so I am going to see if she needs anything.  Her husband (yes the Muslims are all married). He left to go get something down the road.  They just told me that they wanted to change their baby’s name…. so I’ve gotta go!

           

Almost taxi birth…

 

 

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Here is a picture of me eating a tropical ice “Sunday” with fruit.  It was called halo halo. This was my lunch and included shaved ice on the bottom of the bowl , with a creamy liquid poured over it.  Chunks of tropical fruit such as avacado’s bananas, mango’s and others, are put on top of the ice.  This is then served with a scoop of purple and white ice cream of undistiniguishable flavor, and a squirt of additional fake cream…  It did taste good, although sweeter than what I am used to right now.  I haven’t had hardly any sugar at all here.  This picture is taken in the food pavilion in the mall.  Eating out is very common and cheap.  The restaurants serve food that is very different from ours and have signs advertising names of dishes like squid balls, raw fish of many kinds, all manner of vegetables and sauce, whole little pigs and chickens,  turning slowly over hot coals, and even hotdogs, encased in a waffle, on a stick. Rice is served everywhere, even in the “American” style restaurants serving pizza, chicken and spaghetti….even McDo’s (McDonald’s) serves rice!

 This morning, right away, I started with an “almost Taxi” birth.  She arrived in a taxi, but barely made it to the bed.  As soon as I had her feet up and she was lying down, she started to push.  No time for vitals here.  Couldn’t even find heart tones…. baby was too low and on his way out. 

            I had just finished assisting Julia with a birth, and then ushered in a new laboring mom that was barely started contractions (her water broke). As I was starting the vitals on her (Blood pressure, temp. baby heart tones…. Ect..),  I heard “Cher!” (that is what they call me here).  “Laboring mom and she is pushing NOW!”

This mom was 24, and it was her 3rd baby.  She was totally calm, but was obviously uncomfortable sitting in the chair on the baby’s head.  As Aute’ Susan quickly, quickly, wheeled her through the back door, and over to the bed made up in the corner, I grabbed a birth cart and the oxygen tank and yanked the curtains closed around the cubicle and yanked on my gloves. 

                        We got her up on the bed, I got the big pad under her bottom, and there was the baby’s head visible.  I have really been working on head control in fast births, because after Julia’s experience with the explosion of the baby’s head out, making its own hole, I can see that head control is very, very important.  I really held this head back hard, trying to get her perineum a chance to stretch and the shoulders not to blast through and make a rip.  Her water broke, just as the head was crowning.  There was moderately thick meconium, so I knew that they were going to want to do deep suctioning with the machine on the baby as soon as he was born. Thankfully, she did not tear.   As the baby was born, he gave a good yell and pooped a bunch more on the way out. Now my bed was a mess, but I was glad to see that he was lying there safe and sound. 

            While the little fellow made no mistake about wanting to get out quickly, mama’s placenta took a little over a ½ hour.  I was just thinking about getting some action going by getting her up into a squat on the bed, but then it came with some gentle traction. Only moderate bleeding this time.  Everything looked great. I did give her a shot of pitocin, to control bleeding, since the placenta was so long in coming… (not my idea).

            This mom was so strong.  She wanted me to let her go home about 2 hours after the birth.  All moms must stay 6 hours and this is very hard for some.  Her bana came and laid down on the bed with the baby and took a nap, while she watched over them both for several hours in a hard chair by the bed.  Earlier I could tell that she was definitely the one in charge here with the family.  She gave him all kind of grief for the baby soap not being in the bag, and this and that, that I couldn’t understand. But the expression on his face was enough to say that he’d messed up.  But, obviously she cares well for her family and gives of herself a hole bunch… letting him and baby sleep while she took the chair.

The baby was a little boy and they named him Aierl.  Here is a picture of him.

            Julia’s little girl that I assisted, was named Ashly Mae. Here is a picture of her, too.

           

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            Just before lunch, a woman came in that had delivered here about 6 weeks ago.  She had a breast infection about a month ago and we had sent her to the doctor for antibiotics.  It didn’t work. The wrong antibiotic for the wrong bacteria.  Now she has huge gaping hole 3 inches across and 1 ½ deep, a crator, in her breast, where the infection has eaten away and made its way out.  Milk and green pus leaks out of the hole and it looked very, very painful.  The mom had not gone back to the doctor for different antibiotics, assuming that it was her fault that they were not helping.  Doctors are like “God” here and they can intimidate a young mom from ever seeking further help by being rough or insulting. The breast is ruined and she will need surgery before gangrene sets in, or even tetanus.  Tetanus is very rampant here, as is leprosy and gangrene.  Thankfully, here at the clinic, tetanus must be current by 28 weeks, and I have given more than my share of tetanus injections these last few weeks!

 Staph infections are very common, as it is on the skin at all times anyway, but it grows better here in the constant humid warmth.  That is why I don’t dare break the skin on one of my mosquito bites.  I carry itch medicine with me where ever I go, so that I do not scratch.  An intern here last year got a septic infection from scratching a mosquito bite through the skin, and had to spend a week in the hospital (the nice one downtown, not the government one where I take moms) on IV antibiotics.  That would not be a way I would like to spend my time here!

            So, infections are very common in this environment.  That is also why they do not allow us to do many internal exams.  Back at home, we check for dilation and check for an anterior lip and a check for this and that.  Here you usually only get one chance to do an internal exam and that is on admission.  With it, we have to determine if there is going to be enough room for the mom’s bones to move, so the baby can come down, to see what the baby’s head is doing on it’s way out,( if it is cocked to the side), or if the baby is breech or otherwise odd presentation, if she is dilated and effaced, if the water is broken, if the tissue is healthy, and if there is going to be any problems with the decent of the baby at the vaginal opening, with the muscles and tissue at the very end.  It is a lot to try to take in on a 2 minute or less exam.  But they are really trying to minimize the chances for infection.  Even so, they give out antibiotics with all suturing and for any other reason.  They are really going through the amoxicillin and cephalahexin that I brought. 

            For lunch today, the cook in the clinic made a really good chicken curry, served with white rice.  She had grated the coconut by hand and squeezed out the milk and cream and discarded the grated coconut meat.  Then she braised the chicken pieces and added them to simmer in the coconut milk curry sauce.  It is amazing to me that they do not try to cut the chicken in recognizable pieces.  It is common just to chop the chicken in bite size chunks, bones and all and then just cook it that way.  Everyone is always picking bones out of the side of their mouth, but that is what they do all the time with the fish they have for every meal anyway, so it looks normal.  They did have fish again today and it wasn’t too salty this time. They often serve a dried fish and eat it with most meals, that is way too salty for me.  I don’t mind the fishy taste, but the salt bites my tongue.  This particular fish had been dried and then steamed and wasn’t too bad.  It reminded me of trout, although didn’t look anything like one.

            The curry today had potatoes, carrots, the coconut milk, ginger and lemon grass.  I really do enjoy the curries and they never make them too spicy. Yesterday’s soup had plantains (look like banana’s but don’t really taste like them) and was thicker from the addition.  Another amazing thing to me is the common practice of not refridgerating food.  The cook will make a big lunch (enough for dinner too) and it will sit on the stove (with the stove off) for hours, sometimes all night and the next day, until the new food is being cooked.  No one gets food poisoning.  I just do not understand.  I am very careful to smell the pot before I take, after Julia’s blind trust, and soured pork veggies the other day!  I suppose, if one heats it up really well, that the spoil bacteria that would make me sick would be gone.

            The clinic cook is a real sweet heart.  She loves to please everyone and makes treats to share.  She also does all the kitchen cleaning and mopping, along with making shopping lists and organizing meals.  Yesterday she made little spring rolls for dinner and some of us found out about it, including me… and we snitched some from the basket as they were piping hot and so delicious.  I think she was a little frustrated, as when I went back in for a drink of water from the cooler, there was a sign on the bowl with exclamation mark “This is for dinner only!”  She gave me a big smile this morning when I walked in to work, so I guess she doesn’t stay mad very long.

            There are other ladies that work as people who clean, ladies who do the laundry (not the bloody stuff) and keep things tidy.  Sweeping, yes there is constant sweeping going on…. with shorter, whispy, wide brooms, made of a soft, fibrous plant.   It is a common practice here to have household help.  In fact, nationally, household help makes up for 40 percent of the jobs in the nation.  Even the fairly poor have household help.  Women that live with their bana’s, that are not married, are officially called  housekeepers on their child’s birth certificate.

            I am sitting here, with my fan blowing on me constantly and I am still sweating bunches.  My skin is always sticky, my clothes are always damp from my sweat, and I cannot tell you how much I am looking forward to that air conditioned plane on the way home.  For that will be the end of my stickiness.

            I am off for the evening and just woke up from a nap.  I am surviving by sleeping and eating when I am not working. The idea of traveling to see the famous beautiful beach doesn’t even appeal to me.  Not without Tom anyway….

           

 

           

                       

           

Badjoe Indians…crazy birth and homesickness

Last night Joyce, Julia and I were invited over for dinner at Mordecai and Toinette’s house for dinner.  They moved to Davao City many years ago from South Africa to do mission work.  They are still supported by their home church there.

            Mordecai was an architech draftsman and Toinette was a school teacher.  Soon after coming here, Mordecai was trained as a missionary medical person and Toinette became a midwife.  They felt called to the mission field and were led here to Davao City to work among the Badjoe Indians. The Badjoe Indians are the lowest tribe here, being boat people.  Yes, they live their entire lives in boats or basket houses held way up in the air on stilts.  They are very poor and are a unique group of people of about 300 families.  They come to shore to shop and to sell pearls.  They are not really very honest (although there surely are some that are).  They claim to have found the pearls in the sea and strung them, but in reality, they go to the mall, buy a string and then sell them at absorbent prices.  We had some at the door of the clinic today.  The mall sells pearls for 300 peso for very good quality.  They try to sell them at 1,000.  Many foreigners will buy them just to say they bought pearls from the Sea Gypsies.

            They have been very closed to all medical help or Christian teaching until Mordecai became their friend.   Birth for them is something to be feared.  They are very concerned about the mother bleeding to death.  After the baby is born, they leave it off to the side and try to keep the mom from bleeding too much.  The floor is made of reeds with cracks and the blood is pushed down into the water.  It is hard to know how much a mom lost that way!  Anyway, the birth process is quite amazing.  The birth mom is covered head to toe with blankets.  The birth granny goes under the blankets to help with the birth.  The mother of the birth mom actually bites her daughter’s ears and pulls her hair, while she is trying to push, in an effort to get her to get all riled up to push harder.  They had invited Toinette (midwife)  to the birth in case the mom bled too much, maybe she could help. After the fact???

            For dinner, as Mordecai and Toinette were telling us all about their ministry to the Badjoe Indians, they served us a real South African meal.  We had cornmeal mush, with a tomato, onion sauce with special spice and skewered BBQ pork.  It was really good.  She got out her precious American cups (like we would maybe treasure something from another country) and made African roobios tea and served a box lemon cake she had made.  It was very touching to be a part of their lives for the evening.  They have a son with autism and we talked about curriculm and speech / language therapy for quite a while. 

            Today in the clinic, I assisted with 2 births that were very nice.  I also did speculum, vag exams on woman who had STD’s and infections of different sorts.  Some of the women were very young (14, 15) and had pretty bad infections from their sex partners.  So many of them did not even know how many other woman their current partner had been with.  Several of the girls were very nervous and I spent most of the time trying to get them to open their legs willingly.  I need both hands for the exam…

Thankfully they had a lamp I strapped onto my head and that freed up my hands some what.  I cannot imagine what these girls are going through in life.  And now they are pregnant.

            It is now 12 days until I am home.  I am truly homesick.  On my days off, it is the worst, as I have time to think too much about what I am missing at home.  My family has been faithfully writing me and that helps a whole lot.  I spend a lot of my time on the computer conversing with Tom, writing my Xanga blog, studying for ATM test when I get back and writing the kids and friends.  I am also thankful for the diversion of my CD player with hymns and songs I enjoy.  My computer doubles as a private movie theater as I can get lost for an hour or two watching Mother Theresa, the Christy series and some other sweet movies the kids thought I should take.

            I am so thankful that I made it through this weekend.  I slept and slept. Tears of homesickness and frustration (I am sure Tom was worried) shed and past, I think we’re through the worst of it.  But now I am now going into a tough week as far as my schedule and am going to need every ounce of strength I have left to make it.  Exhausted physically and mentally, my brain is on overload from all the details of what I have learned.  Oh, I hope I can remember it all when I need it! 

As far as coming home,  I so much want to get off the plane looking like a beautiful wife and mommy, coming home at last, joyful and ready for action, but instead I’m afraid I am going to look like something the cat drug in from the woods…. Yikes. 

            Joyce left today to come home.  Julia leaves Thursday, Lisa and Beth leave on the next Monday and then I leave on the 13th.  The 12 new students all arrive this Friday.  Jordan Geyman (Dr. Troy Geyman’s daughter) arrives on Friday and it will be good to see her.  We are sharing a room for the time I am here.

            I went shopping today for the rest of the gifts I am bringing home and some things for Sue Struble, a midwife that was here when I first came.  She wished so badly that she had gotten pearls for all of her daughters and it was a whole lot more cheaper for me to get  them for her, than for her to come back and get them!

            Today, it was dusk by the time I was making my way home from the mall, about 1 mile away.  I used a peddle cab driver, as the roads were packed with taxi’s and cars.  Joyce was about to leave for the airport and I really needed to get home quickly to say goodbye. He was about 15.  He was very nice (too nice) and sang American love songs to me all the way (way off key).  When I got home, and after I paid him, he hung around the gate, still singing, peering in the gate and saying that he was in love with me!!??!!  ‘crazy kid!   I think he wanted money.   Carmen went and told him to go away and that I was the mother of 11 children (or something to that effect) anyway he left….   Now I am a little nervous about going out in the dark to the clinic, but thankfully the clinic guard is right near and within ear shot.

            My shift starts at 6:00 am tomorrow.  I was late to work this morning due to a misunderstanding about where I was supposed to be.  Ate’ Susan had asked me to do the exams today last Friday and my schedule says that I was on day shift for clinic also.  Assuming that Ate’ Susan took my name off clinic and put it on for the exams at 8:00, I took my time getting up and eating breakfast.  As I was talking to Tom on the phone, Carmen came up the stairs getting off night shift and she whispered… “Where were you? You are on this morning!?”  I honestly did not know that I was supposed to be two places at once, but I was… oooops…

            Please pray for the baby born yesterday, with an Apgar of 2.  It was the worse case of shoulder dystocia that the clinic had ever seen here.  It was actually my client I had worked with all night, with a very slow labor. I went home in exhaustion a couple hours before birth.  She finally got the head out and there it stuck.  They tried about everything.  They cut in several different directional episiotomies, they were trying all the tricks and still this baby was very stuck.  5 mintues later, the baby finally was worked out.  Jonna was standing on the bed, doing supra pubic pressure and actually broke the bed with her force down.  (In the middle of it all!) The birth mom had her knees up around her ears pushing and pushing.  It turns out that the baby had his hands locked behind his back and they could not bring them forward without breaking them.  There was blood, amniotic fluid and stuff everywhere.  About 2 mintues into this thing, one of the girls rang the emergency bell that sounds upstairs where all the senior midwives stay.  It rang quick once and they thought…  it was just an accident.  Then the girl hauled on it and then they jumped up (many were not quite dressed yet and dressing flying down the stairs.  Aute’ Susan was trying to put the wrong garment on her head…)  they arrived and worked and worked, finally getting the rest of the body out.

            The baby lay there limp and white, not breathing.  The heart was beating, though, so we did eventually get the baby to breathe with much resuscitation.  The baby didn’t really pink up. We transported the baby immediately as the baby was breathing in little gasps, little gasps, pulling in his chest so hard in an effort to get oxygen and really struggling.  The mom seems fairly uncomprehending about the whole thing, or else she doesn’t care.  She is still smiling and she went home this afternoon, her baby still in the hospital.

            Amidst the poverty and differences, I see a real sense of pride and modesty that is lacking in America.  To be covered during birth is very important. In spite of huge poverty…they very much want to repay kindness with kindness and just a tiny gesture and word of encouragement goes a huge mile.  I just love to compliment the moms if they are doing a good job.  They just beam with happiness and work even harder.  Most moms do not have diapers and so I bought a big pack of Pampers to give each of them a few out of, so they can go home in style.

            Little Peanut came in today with his mommy and he looks great.  (He was my baby that was just under 4 lbs a few days ago.)  Friday he came in and his temp was 102.00  I was horrified and ran to get Aute Anna, my supervisor on shift.  She looked at the baby awhile and said, “I think that he is just hot from being outside.  Unwrap him and cool him off.”

  I did and sponged him off as well and sure enough he cooled right down.  I guess a little one that small does not regulate their temperature on their own very well… Feeling a little foolish, I guess I will remember that lesson now.  It was a scorcher outside and I had scheduled them for 3:00 pm to travel in the hot sun. I made their future appointment for 5:00 pm.